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This Patient Needs Sedation and a Second Opinion

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I’m in a new city and developed a bit of a toothache on a tooth that already had a filling. It seems to come and go, but I was concerned so I went to the dentist. That’s was actually a huge deal for me because I hate going to the dentist (no offense). He said he could tell by the x-ray that the tooth was almost completely eaten away. He wanted to extract it and begin the process for bone grafting and a dental implant. He did give me an antibiotic in preparation and asked me to schedule out front. I wanted to double check before I did that. It took almost everything for me to go to the dentist this time. I don’t think I can get through an extraction. Can you think of another option?

Felicity M.

Dear Felicity,

An image of someone's eye closed, maybe from sedation dentistry

Please bear in mind that I haven’t examined your tooth, but I will admit that something sounds fishy about this. If your tooth were really in that bad of shape, you should have been in pain for quite some time and not a come and go type of pain.

Not only that, but a cavity that large would have been visible to the naked eye. Not only would he not have needed an x-ray, but the filling would have almost positively fell out…or into the filling. I strongly feel you need a second opinion.

When you do get your second opinion, don’t let them know the first diagnosis or who you went to see. Instead, just go there and describe your symptoms. That way the dentist won’t feel pressured to back up a peer.

You may find all you need is a simple filling or porcelain crown.

Dental Sedation to Make Dental Visits Anxiety-Free

It’s normal that the idea of you going to yet ANOTHER dental appointment is probably leaving you with cold sweats, but let me put your mind at ease. Many patients who deal with dental anxiety, some so extreme they have a panic attack at the idea of going to the dentist have found going to a sedation dentist to be just the solution they needed.

For some with mild anxiety, just getting nitrous oxide (commonly known as laughing gas) is enough to relax them and allow the local anesthetic to work. Others need a stronger form of oral conscious sedation. Many patients don’t realize that dental anxiety makes it harder to stay numb with the local anesthetic, which contributes to their fear of the dentist to begin with.

This could be a life-changing experience for you.

This blog is brought to you by Dr. Theodore Hadgis.

What Happens If You Picked the Wrong Dentist to Do Your Smile Makeover?

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I think I made a hasty decision. I wanted a smile makeover and mentioned it to my dentist. He said he knew how to do one. I was so excited about getting it done, that I just agreed without doing any research. I know— stupid. It turns out that knowing how and good execution are two different things, but I’m guessing you already knew that. Getting them was super easy and completely pain-free so I have no complaints there. I do worry about the fact that they’re off center. My dentist insists they’re in the perfect spot and I must be looking at them from an angle. But, I think he’s embarrassed. Is there any way I can fix this? Now all I see when I look in the mirror are those off-centered front teeth.

Delleth A.

Dear Delleth,

Grosse Pointe Porcelain Veneers

I’m sorry you’ve had a disappointing result. You’ve also put a pin right on what your dentist is likely feeling. He told you he could do it and then ended up botching it. Everyone wants to be known as skilled at their work.

Porcelain veneers are unique in that it takes more than skill. It also takes an artistic eye and a great deal of training along with it. A skilled cosmetic dentist would have noticed the position issue and never have bonded in place. Even if they had, they’d not be satisfied with the results. They’d rather do the whole procedure over than have a sub-par result. In fact, most true cosmetic dentists have a beautiful smile guarantee.

It sounds like your veneers have already been bonded on. Unfortunately, the only way to fix it at that point is to do the whole case over. You’re welcome to give him another go. Tell him you’re unhappy with the results and he can either re-do the smile on center or give you a refund.

If you decide to go with the refund and another dentist, Look for one who has reached accreditation level with the American Academy of Cosmetic Dentistry (AACD). They’re among the most skilled cosmetic dentists in the world. You’re sure to get stunning results.

As to the crookedness, for now, I want to show you a couple of pictures that may make you feel better in the interim.

Tom Cruise Porcelain VeneersTom Cruise porcelain veneers with centering line

As you can see from Tom Cruise’s pictures, you’re not the only one whose dentist placed their porcelain veneers on off-center. It drives me crazy every time I see the images but most people don’t notice and think he’s nice looking. So, every time you’re feeling insecure about your smile while you’re waiting on the repair, you can say to yourself, “I have something in common with Tom Cruise.”

This blog is brought to you by Dr. Theodore Hadgis.

Can You Please Explain The Difference Between TMJ and TMD?

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I’ve been getting horrible migraines when I first wake up. I was talking to a friend about it hoping she’d know what would give me some relief. She told me there’s medicine I can take that will relieve me of pain. But, the more important thing is to get to the reason why I keep getting them. That’s what I love about her. She gets right to the point. Aside from some tests she suggested I have my doctor run, she also mentioned TMD as a possibility. I looked that up and it seems there are similar symptoms with that and TMJ. What’s the difference between the two?

Caroline G.

Grosse Pointe TMJ Dentist

Your friend is bright, as I’m sure you know. It’s always better to get to the root of an issue rather than just medicate it to mask the symptoms. She’s also right that TMD could be the cause of your migraines as well. However, there are usually other symptoms which go along with that, such as pops and clicks in your jaw.

It’s worth looking into though, especially if there have been changes in your bite. The terms TMJ and TMD are used interchangeably.

TMD refers to Temporomadibular Disorder.
TMJ refers to the Temporomandibular Joint, also known as the hinge joint.

It’s the joint that’s usually the problem and cause of the disorder. If it’s not in its proper place, it can cause loads of problems for you, including migraines.

TMJ treatment can vary. One end of the spectrum is simply wearing an orthotic device, temporarily, which will help guide your hinge joint into place. On the other end of the spectrum would be major reconstructive work. Skilled TMJ dentists will also start with the least invasive solution possible based on your diagnosis.

It’s important you go to a dentist with a lot of testing specifically for this type of situation.

This blog is brought to you by Dr. Theodore Hadgis.

Can Dental Sedation Kill Me?

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I am the queen of “What could go wrong?” I see the possibilities of death everywhere. Even when my appendix became inflamed I made a pro/con list to decide whether I had a higher chance of dying from the surgery or from the appendix. I opted to wait until my appendix burst, which it did. Then I had to have surgery. I was pleasantly surprised that I woke up afterward. So, you can see that I’m a little frightened of things which I have little control over. I’m having a dental procedure. My dentist said he highly recommends I have sedation because of my anxious nature. However, I can’t help but worry that this can kill me the way anesthesia from surgery can.

Miranda K.

Miranda,

Grosse Pointe Sedation Dentistry
You’re not alone in your fears. In fact, many Americans are on anti-anxiety medications for that very reason. While there is risk with any procedure, sedation dentistry is very safe. In fact, in the case of some patients such as those with heart disease, epilepsy, or those at risk for stroke, using sedation actually makes the procedure safer.

This is completely different than the type of sedation you get with surgery. Dental sedation is called oral conscious sedation. You have control over your bodily functions throughout the procedure, but are completely relaxed. Most people simply sleep through the procedure.

The thing to do is speak with your dentist about all the risks. Then, ask him about the precautions he takes. For instance, is there someone in the room keeping an eye on your vitals throughout the procedure? What are their procedures if something goes wrong? Knowing the answers to these things likely will put your mind at ease.

You should know that patients who try sedation dentistry often say it changes their life. Where they used to be terrified of the idea of going to the dentist, now they look forward to it. You’ll also find you’re able to do more work during each appointment. So, whether you need several fillings, several crowns, or tooth extractions it’s much easier to have the work done all at once instead of going to office several times.

This blog is brought to you by Dr. Theodore Hadgis.

Is It Safe to Get My Smile Makeover Through Groupon?

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I’ve wanted a smile makeover for ages. It’s just been outside of my affordability. Today I saw a Groupon in my email offering a smile makeover with porcelain veneers. It’s being offered for less than half the price which I’ve been quoted by most other dentists around town. I’ve scheduled an appointment with the dentist and was about to hit “purchase” but I started having doubts. This is still a lot of money. Is it safe to do it through Groupon?

Callie A.

Dear Callie,

The answer to your question mostly depends on the dentist offering the Groupon and why he’s offering it so cheaply. Cheap can sometimes end up being very costly. I know Groupon offers generally have a time limit, but see if you can get in to have a consultation with the dentist before purchasing. The first thing you’ll want to be sure of is whether you’re actually a candidate for porcelain veneers. I’d hate for you to purchase something nonrefundable only to find out you can’t have the work done.

Here’s what you want to check out with the dentist doing the offering. How much experience and postgraduate training does he have in aesthetic dentistry? Does he have a smile gallery you can look at to see the results he’s achieved with actual cases he’s done? Does he offer a beautiful smile guarantee?

While all dentists are capable of doing a smile makeover, not all of them do it well. Don’t spend a ton of money only to get disappointing results. There have been many smile makeover disasters where their new smile ended up worse than their original smile.

Be bold in checking out your dentist’s credentials. The best, most artistic dentists are accredited with the American Academy of Cosmetic Dentistry, though there are still very artistic dentists who are working toward accreditation. If it turns out, while looking over the dentist’s smile gallery, you realize this dentist doesn’t get stunning results it’s in your best interest to find another dentist—even if it means not getting the Groupon.

This blog is brought to you by Dr. Theodore Hadgis.

Are Headaches Really a Dental Problem?

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I think my doctor is blowing me off because he doesn’t know what to do. I’ve been having horrible headaches for months now, especially in the mornings. He’s done CT scans and all kinds of lab work, but can’t seem to find the real cause. At my last appointment, he told me to see a dentist. Is he just passing me off or can a dentist really help headaches?

Gracie L.

Dear Gracie,

I don’t think he’s just passing the buck. I think he’s more out of ideas and knows this is a possible solution. My doctor once told me when he can’t find what’s wrong with a patient who just “doesn’t feel well” for no explicable reason, he sends them to the dentist. There’s usually a beginning tooth infection. When it’s dealt with the patient suddenly feels better.

Our oral health directly affects our general health as well. In your particular case, it’s likely your doctor thinks you might have TMJ Disorder, especially if your headaches are strongest in the morning. TMJ has been known to cause migraines. It can also lead to jaw pain and popping. Some more severe cases even cause your jaw to lock-up on you.

I wouldn’t just see any dentist, though. Make sure you go to one with significant TMJ/neuromuscular dentistry training. For instance, Dr. Hadgis did post-graduate studies at the Las Vegas Institute for Advanced Dental Studies, which is known worldwide for its expertise in dealing with TMJ issues.

In many cases, TMJ can be dealt with using simple solutions. But, if yours is more complicated and some crowns need to be done you want to be certain your dentist truly understands how your bite needs to come together to fix your TMJ. You don’t want someone who’ll make it worse.

This blog is brought to you by Dr. Theodore Hadgis.

Should I Be Worried About Sedation Laws?

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I just learned that my state, California, is changing sedation laws. I’m scheduled to have wisdom teeth removed soon. I’m trying to figure out which is safer, before or after the new laws. I just can’t figure out what the new laws mean and my dentist just keeps telling me not to worry about it. Well, I am worried. So…help!

Shonda R.

Dear Shonda,

I looked up what I think you’re referring to. These are proposed changes to the sedation regulations. If passed, they will begin in 2019. However, the changes mostly affect children. I’m not surprised you had trouble understanding what the proposed changes are. The literature I came across about it was all in “doctorese”.

Sedation dentistry is safe. It sounds like you’ve tried to ask your dentist questions and were getting blown off. By the way, that’s not a good thing. With the best dentists, you can ask as many questions as you need AND expect answers. If your worried, sometimes it helps to have something specific to ask. It pins them down. Tell him (or her) you want to know the safety protocols. There should be someone monitoring your vitals and someone there for emergencies. Those things should be in place even without the changes. If for some reason they aren’t, switch doctors. But, I’d be very surprised if they’re not. These type of requirements are already on the books in most states.

The thing which concerns me about this new legislation is the cost. Not from a doctor’s standpoint but from a patient’s. These new changes don’t realistically have benefits that outweigh the costs. What they will do is increase the expense and make it impossible for many low-income patients to receive the best care. That worries me.

Don’t put off your procedure. If you need wisdom teeth removed, the younger you have it done, the better. Patients who wait to have their wisdom teeth removed tend to have more complications. Having it sooner instead of waiting two years for regulations which won’t do anything except cost you more is in your benefit, both fiscally and medically.

I hope this helps you put your mind at ease.

This blog is brought to you by Dr. Theodore Hadgis.

Why Is It Hard to Bite and Speak After Porcelain Veneers?

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I got porcelain veneers. The temporaries felt fine, but when he put on the permanent ones something has gone wrong. My bite feels different and it hurts when I bite down. Plus it’s hard to speak because my tongue keeps bumping up on the back of them. I wonder if he made the backs too thick? I’ve come back a couple of times and he’s adjusted them, but it’s still not any better. I think he’s frustrated with me because the last time I called he said I’d get used to them. It’s been a few months and not only have I not gotten used to them and now I’m getting headaches, though that’s likely unrelated.

Paula L. – South Carolina

Paula,

Are you sure your dentist gave you porcelain veneers? Based on what you’ve said, it sounds more like your dentist gave you porcelain crowns instead. Porcelain veneers are only on the front of your teeth. Your tongue wouldn’t push up against the back of them. Even if they were made too thickly, it would only affect the fronts of your teeth. It’s crowns that surround your teeth.

I’m concerned about some of the things you mentioned as being problematic. The pressure on your bite worries me. If your bite shifts inappropriately, it can cause you to develop TMJ disorder. This can become quite painful and even lead to lockjaw. It also leads to headaches, which you’ve mentioned has recently become and issue for you.

It’s actually your dentist’s responsibility to repair this, but if he’s not following up on his duties, I’d go to a dentist with some expertise in TMJ and get a second opinion. At the least, if the original dentist messed up your bite, you should be able to get a refund and have the procedure done correctly by someone who knows what they’re doing.

I’d also like you to look at your bill to make sure of which procedure you were billed for. If he charged you for veneers and you received crowns, that’s fraud.

This blog is brought to you by Dr. Theodore Hadgis.

My Friend Says Invisalign Is Giving Me TMJ

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Can you advise me? I’ve been on Invisalign treatments for several weeks. Recently, I started having jaw pain and massive headaches. A friend insists it’s Invisalign giving me TMJ. I don’t want to stop these treatments if she’s wrong. I’ve been looking forward to having straight teeth for many years. Do you have any recommendations for me?

Lucy N.  – Denver, CO

Lucy,

There are many causes for TMJ. Some are genetic. Some are lifestyle related. Stress can be a major cause if it’s leading you to clench down. You could even be doing that without realizing it. Biting down or tensing up adds stress to your jaw joint. That can lead to both head and jaw pain. Sometimes medications you’re on can lead to clenching, such as Adderall. If you’re married, ask your husband to keep an eye out for you grinding your teeth at night.

Orthodontics, including Invisalign, aren’t generally a cause. In fact, improving your bite can actually improve TMJ. That being said, if you already had some mild TMJ, adjusting your bite could be aggravating symptoms that weren’t as noticeable before.

I’d see your dentist. He’ll examine your jaw and bite, as well as run other diagnostic tests, to see if they can run down the root cause of your pain. It doesn’t necessarily mean you won’t be able to continue your treatmment. If for some reason you have to it would only be temporary while you and your dentist figured out the best way to treat you. Then you can resume treatment.

Occasionally, someone isn’t a good candidate for Invisalign. If that is the case with you, don’t despair. There are other ways to give you a gorgeous smile. A good cosmetic dentist with experience in neuromuscular dentistry will be a key component for you.

This blog is brought to you by Dr. Theodore Hadgis.

Will My Medicine’s Keep Me From Dental Sedation?

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I take more medicine than an 80-year-old, including for anxiety and depression. I also take some narcotics for pain. I’m in a lot of pain and likely need a procedure I don’t want to do without sedation. I’m afraid if I tell the dentist all the medicines I’m on he won’t want to give me the sedation. Can I just check them against a list and get the sedation without telling him about the medicines?

Josephine S. – Bigelow, AR

Josephine,

It’s never a good idea to hide what medications you’re on. There are contraindications that can have serious consequences, including death.  It’s extremely important your dentist gets a list of all your medications, even over the counter. Make sure to include the dosages you take as well.

It’s unlikely you can know ahead of time which sedation medications your dentist will use. Each dentist has different preferences. The only way to know ahead of time would be to speak directly to the dentist.

Your best bet is to call the office ahead of time and let them know exactly what medications you’re taking. This way the dentist can prepare for your needs.

You’ll likely find the sedation takes care of your anxiety on its own. If you’re in pain, it generally indicates there’s an infection somewhere. The sooner you get this treated, the better.

What could be dealt with by a simple filling, could blow up into needing a dental crown, or worse, an extraction.

This blog is brought to you by Dr. Theodore Hadgis.